Rationale and design of the BA-SCAD (Beta-blockers and Antiplatelet agents in patients with Spontaneous Coronary Artery Dissection) randomized clinical trial.

INTRODUCTION Y OBJECTIVES: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Most patients are empirically treated with beta-blockers and antiplatelet drugs. The Beta-blockers and Antiplatelet agents in patients with Spontaneous Coronary Artery Dissection (BA-SCAD) is an academic, pragmatic, prospective, randomized, open-label, blinded-endpoint clinical trial, performed under the auspices of the Spanish Society of Cardiology, to assess the efficacy of pharmacological therapy in patients with SCAD. METHODS: Using a 2 x 2 factorial design, 600 patients will be randomized (1:1/1:1) to: a) beta-blockers (yes/no) and b) "short" (1 month) vs "prolonged" (12 months) antiplatelet therapy. Only patients with preserved left ventricular ejection fraction will be randomized to beta-blockers (yes/no) because patients with reduced left ventricular ejection fraction will receive beta-blockers according to current guidelines. Similarly, only conservatively managed patients (ie, no coronary intervention) will be randomized to the antiplatelet stratum, as patients requiring coronary interventions will receive 1-year dual antiplatelet therapy. The primary efficacy endpoint includes a composite of death, myocardial infarction, stroke, coronary revascularization, recurrent SCAD, and unplanned hospitalization for acute coronary syndrome or heart failure at 1 year. The primary safety endpoint will be bleeding. All patients will be clinically followed up yearly. A comprehensive set of additional substudies (clinical, imaging, revascularization, biomarkers, inflammatory, immunologic, pharmacogenetics, and genetic) will be conducted to ensure a holistic view of this unique and challenging clinical entity. CONCLUSIONS: The results of the BA-SCAD randomized clinical trial will advance our knowledge in the treatment of patients with SCAD. The study was registered at ClinicalTrials.gov (Identifier: NCT04850417).

Lanthanide complexes as imaging agents anchored on nano-sized particles of boehmite.

The synthesis of boehmite nanoparticles modified with lanthanides (Eu, Tb and Gd) is described. Their synthesis, characterization and in vitro assays with HeLa cells were performed. The nuclear magnetic relaxation dispersion (NMRD) profiles of the two chelating moieties were studied. Imaging data from laser scanning confocal fluorescence microscopy and flow cytometry revealed that the nanoscaffolds were taken up by the cells, distributed throughout the cytoplasm and showed no toxicity. This platform could represent an alternative to silica-based inert matrices as imaging vehicles.

Bases moleculares de las interacciones leucocito-endotelio durante la respuesta inflamatoria / Molecular basis of leukocyte–endothelium interactions during the inflammatory response

El proceso de extravasación leucocitaria, un paso crucial de la respuesta inflamatoria, implica la migración de los leucocitos desde la corriente sanguínea hasta los tejidos diana donde ejercen su función efectora. La extravasación de los leucocitos está orquestada por la acción conjunta de receptores de adhesión celular y factores quimiotácticos, e implica cambios morfológicos drásticos tanto en leucocitos como en células endoteliales. De este modo, constituye un proceso activo para ambos tipos celulares que promueve la rápida y eficiente llegada de los leucocitos a los focos inflamatorios sin comprometer la integridad de la barrera endotelial. Este artículo revisa la extravasación leucocitaria, con especial hincapié en los hallazgos más recientes en este campo, tanto desde el punto de vista molecular como mecanístico. Incluye la descripción de nuevos pasos en la cascada de adhesión tales como el enlentecimiento del rodamiento, la locomoción intraluminal o la ruta alternativa de migración transcelular, así como el papel funcional de nuevos receptores de adhesión, la organización espaciotemporal de los receptores en la membrana plasmática y las rutas de señalización que controlan los diferentes estadios del proceso de extravasación (AU)

The process of leukocyte extravasation, a critical step in the inflammatory response, involves the migration of leukocytes from the bloodstream towards target tissues, where they exert their effector function. Leukocyte extravasation is orchestrated by the combined action of cellular adhesion receptors and chemotactic factors, and involves radical morphological changes in both leukocytes and endothelial cells. Thus, it constitutes an active process for both cell types and promotes the rapid and efficient influx of leukocytes to inflammatory foci without compromising the integrity of the endothelial barrier. This article provides a review of leukocyte extravasation from both molecular and mechanical points of view, with a particular emphasis on the most recent findings on the topic. It includes a description of newly revealed steps in the adhesion cascade, such as slow rolling motion, intraluminal crawling and alternative pathways for transcellular migration, and discusses the functional role of novel adhesion receptors, the spatiotemporal organization of receptors at the plasma membrane, and the signaling pathways that control different phases of the extravasation process. for transcellular migration, and discusses the functional role of novel adhesion receptors, the spatiotemporal organization of receptors at the plasma membrane and the signaling pathways that control different phases of the extravasation process (AU)

Interleukin-15 and interferon-gamma participate in the cross-talk between natural killer and monocytic cells required for tumour necrosis factor production.

We have characterized the lymphocyte subset and the receptor molecules involved in inducing the secretion of TNF by monocytic cells in vitro. The TNF secreted by monocytic cells was measured when they were co-cultured with either resting or IL-15-stimulated lymphocytes, T cells, B cells or natural killer (NK) cells isolated from the peripheral blood of healthy subjects and from the synovial fluid from patients with inflammatory arthropathies. Co-culture with IL-15-activated peripheral blood or synovial fluid lymphocytes induced TNF production by monocytic cells within 24 hours, an effect that was mainly mediated by NK cells. In turn, monocytic cells induced CD69 expression and IFN-gamma production in NK cells, an effect that was mediated mainly by beta2 integrins and membrane-bound IL-15. Furthermore, IFN-gamma increased the production of membrane-bound IL-15 in monocytic cells. Blockade of beta2 integrins and membrane-bound IL-15 inhibited TNF production, whereas TNF synthesis increased in the presence of anti-CD48 and anti-CD244 (2B4) monoclonal antibodies. All these findings suggest that the cross-talk between NK cells and monocytes results in the sustained stimulation of TNF production. This phenomenon might be important in the pathogenesis of conditions such as rheumatoid arthritis in which the synthesis of TNF is enhanced.